The WHO Can No Longer be the Vanguard of Public Health

Much criticism has been levied against the WHO for the “egregious failure” that was their handling of the Ebola epidemic in Africa. Many experts have since claimed the WHO’s follow up response to Zika in Brazil represents the realization and swift change the WHO took to better handle international medical crises. However, both experiences demonstrate the same level of member state politics that cannot be allowed to determine international public safety. The WHO should not be considered the vanguard of public health, and more authority and funding should be placed in the hands of humanitarian NGOs on the ground, with the WHO acting as an international liaison and support structure.

To claim that the WHO has taken lessons learned from the Ebola outbreak and applied them to the Zika outbreak is misguided; the issues are so completely different it is wrong to compare them. Those affected with Ebola immediately begin experiencing violent flu like symptoms with a high mortality rate. Zika on the other hand, presents with relatively mild symptoms and has a very low mortality rate. In some ways, this makes Zika more insidious, as the infection can spread far and wide without raising any alarm. Ebola on the other hand, has a tendency to burn itself out historically, due to the rapid death toll decimating populations before it can spread far. Medically, they are two completely different monsters, and comparing them is fruitless.

The other issue, even if they were medically comparable, the autonomy granted to regional WHO offices means it is no surprise there was a very different response in Africa and South America. The way the local WHO offices operate is strikingly different, and is not representative of any major institutional changes to the WHO on global scale. Epidemics are not just medical events, but also political events. As an international organization made up of member states, the WHO is subject to politically based funding issues and organizational pressures. When an outbreak happens, the location (rural area in poor state vs. urban area in wealthy state) as well as the medical perception (violent symptoms killing young adults vs. quiet symptoms maiming the elderly) factor into the political response of the world community and member states. A political organization can not respond to a politicized event in an unbiased professional manner, expecting that is idealistic.

The fact that so many died in Africa until Ebola cropped up in western countries before a world response was initiated, but when a few died of Zika in Brazil where the wealthy of the world would soon gather for the Olympics garnered immediate international attention, demonstrates just how determined by politics any response by international organizations made up of member states is. Alternatively, Médecins Sans Frontières, a humanitarian NGO, responded to Ebola with immediate action and attempted to alert the international community long before the crisis reached its peak. Removing politics from world health emergencies allows for a much more level-headed response that isn’t bogged down by bureaucracy.

It is unlikely the WHO will be able to restructure itself in a manner that it can respond much more appropriately to medical emergencies any time soon. One of the biggest impediments to this is the “vicious cycle” the WHO is trapped within, where it receives very little funding due to a lack of confidence from member states, and it cannot regain the confidence of said states without a massive increase in funding and autonomy. Even if the WHO does manage to secure the necessary funding, restructure its organization and operational responses, and successfully respond apolitically to a future public health emergency, there is no guarantee it will continue to in the future. The nature of any international organization that is made up of member states that must continuously approve the budget, provide funding, and resist the temptation to interfere politically, will go through cycles of excellence and ineptitude. There have been many other successes and failures by the WHO in the past, the recent Ebola and Zika issues are nothing new.

Expecting a politicized international organization to be the vanguard of public health the world over is setting the international community up for disaster. Humanitarian organizations like Médecins Sans Frontières have shown that it is possible for an international organization to respond effectively and appropriately; their inability to combat Ebola was because they had to rely on the WHO to sound the alarm and secure international support. These humanitarian organization need to be given much more credence and authority, as well as secured more funding. The WHO can play an important role in coordinating different NGOs and acting as a liaison between them and the international community, providing resources, information, and funding. It is unwise to put all of humanities eggs in one basket, expecting the WHO to always be there to step in and save the day.

One thought on “The WHO Can No Longer be the Vanguard of Public Health”

You make great points throughout this post. It is interesting that you point out that the Zika Virus was given more attention due to politics. Zika seemed to have traversed the vanishingly thin barrier that separates public health and politics as the epicenter of the outbreak was in Brazil, where the disease may have arrived from Africa, as fans attended the 2014 World Cup. The timing of the crisis seems to have given it enormous political impact as Brazil was also faced with political turmoil with President Dilma Rousseff’s impeachment, the annual Carnival, and the Olympic Games. This meant if the spread was not contained, the cost in tourisms revenue may have been potentially devastating to the already struggling Brazilian economy. These variables are absent in the case of the Ebola Virus and therefore, I completely agree with your stance on epidemics as political events. The case of politics intertwined within public health can be argued in cases around the world as the WHO must answer to political actors at the local, national, and international levels in many cases even before it can investigate.
The second point you touch on, and where I again agree with you, is to push for more NGOs involvement in providing resources, information, and funding in so not relying heavily on one international organization (WHO) to grapple with all health epidemics. The World Health Organizations role in the global health governance should indeed be a practical expression of its Constitutional function in acting as, “the directing and coordinating authority on international health work”. This would enable different actors and NGO’s at the national and local levels to contribute more effectively to the health of all peoples whilst allowing the WHO to maintain its role in building the capacity to manage and ensuring incentives to work across the range of organizations that have an interest in public health.

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